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Developing reimbursable clinical pharmacy programs: a goal-oriented approach.

D S Pathak, E G Nold

    American Journal of Hospital Pharmacy
    |November 1, 1979
    PubMed
    Summary
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    This study proposes a model for hospital pharmacies to obtain third-party reimbursement for clinical services. It outlines steps for service classification, protocol development, and outcome evaluation to secure payment.

    Area of Science:

    • Health Services Research
    • Pharmaceutical Services Management
    • Healthcare Economics

    Background:

    • Hospital pharmacies are increasingly offering clinical services beyond traditional dispensing.
    • Securing reimbursement for these expanded clinical services presents a significant challenge.
    • A structured approach is needed to demonstrate value and financial viability.

    Purpose of the Study:

    • To propose a goal-oriented model for achieving third-party reimbursement for clinical pharmaceutical services.
    • To provide a framework for hospital pharmacies to navigate the complexities of reimbursement.
    • To outline key components necessary for successful financial recovery of clinical services.

    Main Methods:

    • Defining hospital pharmacy mission, goals, and objectives.

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  • Classifying clinical services into eight categories to assess reimbursement potential.
  • Developing clinical service protocols, charge establishment techniques, and communication strategies.
  • Implementing methodologies for evaluating program outcomes.

    • Main Results:

    • A comprehensive model is presented for integrating clinical services with reimbursement strategies.
    • Classification of services aids in identifying revenue-generating opportunities.
    • Protocols and communication plans facilitate smoother implementation and stakeholder engagement.
    • Outcome evaluation provides data for continuous improvement and demonstrating value.

    Conclusions:

    • The proposed model offers a systematic pathway for hospital pharmacies to achieve third-party reimbursement.
    • Effective service classification, protocol development, and outcome measurement are crucial for financial sustainability.
    • Adoption of this framework can enhance the financial viability and expand the scope of clinical pharmacy services.